Friday, July 30, 2010

This post was written as part of The Breastfeeding Cafe's Carnival. For more info on the Breastfeeding Cafe, go to www.breastfeedingcafe.wordpress.com. For more info on the Carnival or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com. Today's post is about child-led weaning. Please read the other blogs in today's carnival listed below and check back for more posts July 18th through the 31st! Lately I've been hearing women at my playgroup or in the church mother's lounge passing around the idea that that breastfeeding has "no nutritional benefit" after the first year. Women say this with the implication that the only reason to breastfeed your baby is because it feeds them. I have been responding that even though children at age one and beyond are able to eat table food and therefore do not "need" breastmilk, their immune systems benefit from breastfeeding and they get comfort from the nursing relationship.

But then I decided to do some research. And I found multiple sources of evidence that breastfeeding after the first year does, in fact, have nutritional benefits. And why wouldn't it? Breastmilk is nature's tailor-made food. It is not as if the milk that keeps babies healthy for their first year suddenly becomes diet coke after a year. The fat energy content of breastmilk actually increases with prolonged lactation. It probably changes in composition to meet the needs of the nursing child as she grows and begins to eat complimentary foods.

And even though one year olds can eat a balanced variety of table food, it doesn't mean that they will. Toddlers are notoriously picky eaters. That is why companies design drinks for them to "fill in the gaps" in their diet from the things they refuse to eat. Obviously, continued breastfeeding works the same way. One study of children in Kenya found that the more deficient the food diet of the child, the more nutrition the child got from breastfeeding. Nursing does not provide complete nutrition for toddlers, but it does complement the diet they eat.

When my daugher started solids (we did both finger foods and homemade purees) at 6 months, I followed the recommendations at kellymom. I offered solids about an hour after nursing, so she was never very hungry when she ate and never ate a lot. When she started eating table food around 12 months, she was still nursing a lot and not eating large amounts of food. I was glad that even if she didn't eat much food, I knew she was at least getting nutrition from breastmilk. I knew she was just not ready to wean. No one really seemed to be bothered by the fact that she was still nursing, but we didn't get out much at the time, so not a lot of people even knew. A few months later, after she and I both got sick and my milk supply suffered, she was nursing only to fall asleep. That decrease in nursing increased my fertility, and since we were "not preventing" pregnancy anymore at that point, I got pregnant with my son the following cycle.

At that point, either continuing or stopping wouldn't have affected either of our lives verey much. I knew that nursing throughout pregnancy and tandem nursing are options, but I chose to wean her a few weeks after I found out I was pregnant. We weaned slowly, over the course of about 3 weeks so that my milk would decrease slowly and avoid the risk of mastitis. She learned to fall asleep with snuggles instead of nursing, and it was so gradual, that I didn't even realize when it was the "last time" for her to nurse. I can't imagine mother-guided weaning going more smoothly.

I am grateful that I chose to not to automatically wean at an arbitrary age, like one year. I feel that the choice to wean when we did was the best choice for us, and everyone has to make the best choice for them. People aren't making informed choices if they are basing them on inaccurate information, like the myth that breastfeeding after a year has "no nutiritonal benefit. Here are more posts by the Breastfeeding Cafe Carnival participants! Check back because more will be added throughout the day.

Tuesday, July 27, 2010

Lately, my Understanding "Painless" Childbirth post has gotten a lot of attention. I'm so glad, because much of what is in it is so important for women to know. I have gotten a few comments from women who experienced painless childbirth without hypnosis. I think these stories are awesome and they fit right in with the ideology that birth doesn't have to be painful. Here is one of the comments, explaining the various degrees of comfort for her five births.

[. . . ]I experienced almost painless childbirth with and without drugs and never used hypnosis. I think it is different for everyone..[. . . ]In five births, number one and two were painless with drugs. Number three was painful. Number four was not painful until the last ten seconds and number five was painless

I just started focusing on reassuring the baby and the surges never got painful with four and five. The crowning was not painful on number three and number five.

The contractions hurt on number three (possibly because I was panting to keep the baby in on the dash to the hospital.)

Notice her theory that fighting against what her body wanted to do in order to get to the hospital before giving birth may have caused more pain that was necessary. I have been meaning to write about why I feel my second birth became uncomfortable during second stage, after I was almost completely comfortable for first stage, including transition.

My birth plan said "limit vaginal exams to those I request, unless necessary for a medical decision." This request was ignored soon after my OB started to tell I was getting pushy. She had me get into a good position to be checked (big mistake #1 was getting into that position in the first place, big mistake #2 was not getting out of it) and when I was found to have just a lip of cervix left, she continued to check periodically without saying anything. I didn't really mind much at the time since I was really focused on relaxing through the waves, but I do understand why some women feel violated by things like that. I had read about the flaws of the rule of 10 and wanted to be able to push a little if I felt like it even though I was not "10 centimeters." At first, my OB's advice supported this, and she encouraged me to push only as much as I felt I had to. The waves felt different and I began to vocalize through them, because it felt better to, but I was still using my hypnosis and staying comfortable. I don't know how much time passed, but she must have gotten impatient, so she wanted to try holding back the lip of cervix and having me push, which was extremely uncomfortable.

All of you who work with birthing women, this is important, during birthing, our brains sometimes don't clearly interpret what you mean when you say things to us. When trying to hold back the lip of cervix didn't make it go away, my OB told me to try not to push, though I think now she must have meant to only push as much as I had to, but in my confused birth-brain, I read it as "don't push at all" which was very different from what my body was telling me to do, and I think greatly increased the discomfort and, I dare say, pain that I experienced. It is likely that the fighting my body and the confusion caused the pain, not necessarily the pressure waves. When she started telling me I could push, obviously that implied the lip was gone, but again, I had birth-brain. This (and not getting out of that bed) is why I think I ended up needing to be coached to push him out. Once I started really pushing, it wasn't really painful anymore. Crowning didn't really hurt to me either, just felt like really intense stinging.

Here is another comment from a woman who experienced a painless birth:

I had a painless birth with my fifth baby. It was so painless that I didn't realize it was real until he was crowing. (Luckily my husband recognized subtle changes in my mood and called the midwife, who arrived just in time.)

I did not do hypnosis. I just practiced relaxing my perineum with each braxton hicks. When I was lying in bed, in active labor, I thought I was having BH contractions so I just kept relaxing my perineum.

It didn't even hurt when he was crowning. I tore a little and that stung but not bad at all.

For the record: My son was 10lb 6oz and I have a ridiculously low pain threshold

That is pretty amazing. Her comments illustrate beautifully that women do not have to have an unusually strong ability to endure pain to have enjoyable natural birth experiences--it is not an issue of how much pain you can take, but how you choose to think about the sensation you're experiencing.

In both this story and the previous, the moms did not have the painless experience until they had already been through birth before. These women have probably found a solution to the fear problem by experiencing birth. Since they have done it before, they don't need to fear the unknown. Thinking you're not really in labor would probably reduce the fear, too.

Here is another one, from a midwife

[. . .] I had painless childbirth with all my babies. I think it was because I did unassisted births and no one talked to me or touched me while in active labor. I was able to go into the zone and time seemed to stand still. But every time I looked at the clock an hour had gone by. When it was over I felt like I had just had the best sex ever. I was 17 and had a 5 and 1/2 hour labor with my first.

As a midwife, I try to allow my moms to go to that zone, but I also have to listen to the baby, give drinks of water, etc. I tell my apprentices not to talk to her, just support as they see a need and be aware of the mom's response.

I have discussed unassisted birth before. I do think that women are likely to have more comfortable birth experiences if they can be undisturbed. Undisturbed birth does not necessarily have to be unattended. If a doctor or midwife can act as a lifeguard, then a "best of both worlds" birth is possible. The benefits being able to stay focused and follow your instincts while still having a knowledgeable expert available to step in if they are needed. This appears to be how this midwife practices and teaches her apprentices to practice.

The film's director/producer, Toni Harman, is hoping to get the word out about this film so that the more people who learn about doulas, the more people will hire one and have a better birth experience. If you would like to see this film, you can purchase it on Amazon, or you can visit the film's website to learn about hosting a public screening.

Wednesday, July 21, 2010

A press release today from the American College of Obstetricians and Gynecologists explained that the organization is tweaking it's previously released guidelines for Vaginal Birth After Cesarean, the release states that the organization now includes women with two prior low transverse incision cesareans (such as Dr. Poppy Daniels, the gynecologist who got a lot of attention for her surprise VBAC story), women carrying twins, and women with an unknown type of uterine scar on their list of appropriate VBAC candidates. The press release also clarifies the organization's prior position that VBAC should only be attempted where emergency surgery is immediately available, explaining that while they feel that this is ideal it is not always possible, and that should not prevent women from being given the choice to have a VBAC.

This guideline change likely comes in response to the conclusions of the VBAC Conference held in March 2010 by the National Institute of Health, whose Final Panel Statement called on ACOG to reevaluate their guidelines. There was also an online petition to ACOG with over 1,200 signatures asking for changes in light of the NIH's findings.

Tuesday, July 20, 2010

As part of the communication training in my doula course, I recently read the article Watch Your Language by Diane Wiessinger, MS, IBCLC. Here is an excerpt:

When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, "So what?" Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy--and thus safety and adequacy--of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.

Advantages. When we talk about the advantages of breastfeeding--the "lower rates" of cancer, the "reduced risk" of allergies, the "enhanced" bonding, the "stronger" immune system--we reinforce bottlefeeding yet again as the accepted, acceptable norm.

If we want breastfeeding to be the cultural norm. We have to use language that supports this. I believe the same can be said of childbirth. I often here people say that natural childbirth "has benefits." This is not true. Childbirth without unnecessary intervention is nothing more than a biological norm. If natural childbirth is normal, then medicated birth has risks, drawbacks, and ill-effects. People say babies whose mothers receive no medication are "more alert" and "breastfeed better" right after birth. If we want to normalize natural childbirth, we must say that babies born to medicated mothers are "sleepier" and "don't breastfeed well." Even calling a birth "unmedicated" reinforces the norm to some extent.

Choosing natural childbirth is not about choosing something "better," it is about birthing the way that should be normal for human women. It is about avoiding the risks that come with birthing other ways. This is why I'm glad that Lamaze International chose to use the words "safe" and "healthy" to refer to birth the natural way, in the Six Lamaze Healthy Birth Practices. As their research indicates, many women do not see "normal birth" as meaning birth without medical intervention.

Friday, July 9, 2010

I always love reading about traditions of childbirth in various cultures. I have yet to see anything in a natural childbirth book about birth in the traditional South Pacific. My Mother-In-Law is a Tahitian native (now a naturalized American citizen). She had seven natural childbirths before trying the epidural with her last two to see what all the fuss about epidural was about. She was my doula for my daughter's birth. I decided to do some searching on the internet about childbirth in Tahiti, and I found this beautiful passage from the book The Bounty: The True Story of the Mutiny on the Bounty by Caroline Alexander.

When asked about childbirth in his country, Bligh answered as well as he was able, and enquired in turn how this was done in Tahiti. Queen Iddeeah replied by mimicking a woman in labour, squatting comfortably to her heels between the protective arms of a male attendant who stroked her belly. Iddeeah was vastly amused on learning of the difficulties of Pretanee's women. 'Let them to this and not fear,' she told Bligh, who appears to have been persuaded by this tender pantomime.

I love Queen Iddeeah was "vastly amused" learning how difficult Western women had made childbirth. It appears that she demonstrated a "supported upright position with light touch massage," but all she knew was that this is the technique women on the islands found most comfortable and efficient for birthing. They didn't need a randomized controlled trial of upright verses lying positions or a book on anatomy of the uterus to know about this, they just knew it.

I can't completely know what she meant by "Let them to this and not fear," perhaps that the Tahitian method of birthing would help women not fear birth or that if they used this method and were not afraid, their births would go better. Either way, I agree with her.

This is the first mention I've come across of traditional cultures involving men in the birth process. Most other stories feature women birthing with other women or alone. Even in Western culture, birth was the domain of women until doctors came on the scene. Apparently this was not the case in Tahiti.

Perhaps part of why my husband was good at supporting me during my births is that it's in his blood?

Saturday, July 3, 2010

I signed up for Childbirth International's doula training course this morning! From what I've seen on the student website so far, I really like the way everything is set up. They make it easy for you to find other students in your area, too, which I love. I love that their course is all homestudy and at-your-own-pace, and I especially like that they don't require yearly membership fees to maintain certification.

So I am actually a physician. Doula's may be beneficial in some situations, but you all must remember that the role of a physician is to provide good medical knowledge and advice based on evidence.

Unfortunately, a lot of what physicians recommend is not based in “evidence,” but tradition and/or what looks good in court.There is no evidence that continuous fetal monitoring of low risk labor leads to better outcomes, evidence rules against restricting food and drink, physicians did routine episiotomies for years (and some still do), even though they’re were never proven to be beneficial, evidence suggests that clamping the cord right away may not be best—the list goes on.

Where Doula's may be thought of as positive most have zero training and often times may give inaccurate medical advice which is out of their scope of practice. If people want Doula's there should be a government agency licensing those individuals. As you wouldn't want just any person playing your doctor the same gaves for those helping. If they obstruct what we are trying to do they are not beneficial and can ultimately hurt you. Further, they do not have any medical liability. If you want a Doula they should accept medical liability for the 18 years that OB gyns do.

I am thinking of staring doula training soon, and I have looked at the requirements of various doula training organizations, and most are actually quite extensive. Just because they don’t have medical or nursing education does not mean they are not trained. I personally would not feel comfortable or ethical offering and charging for doula services without training or at least extensive personal research on what I was doing.If you have seen doulas offering medical advice, they are not doing their job.A doula’s role is not to speak for or make decisions for the woman, but to help her find her voice.I know I am a bit vulnerable when I’m in labor, and I think a lot of women are.Too often, this vulnerability translates into the woman’s voice being silenced.Doulas (and birth plans) are there to facilitate communication between the woman and the medical personnel—to encourage her to ask questions and be involved in decisions about her care. To me, doctors and nurses who have a problem with doulas and birth plans really have a problem with women having a voice. If what you are trying to do is not what the woman thinks Is best for her and her baby, then doulas are not hurting the woman by “obstructing” it.I don’t have a problem with the idea of having a system for keeping doulas from acting outside their non-medical role, but if they are really acting in that role, they shouldn’t need to accept medical liability

In regards to birth plans. They are all nonsense. When it comes to the delivery room most if not all mean nothing.

My OB actually encouraged me to write a birth plan for my son’s birth.I stated clearly in my plan that I wrote it to help the hospital staff know how to support me in the way that would be best for me.I think “plan” is actually not a good word for the purposes of this document—it is not designed to plan the details of your birth, but to let your care providers know what kind of care you want—a tool for communication.Then the providers know that if something comes up that conflicts with what you have written, you want them to discuss it with you. Of course, if you don't discuss the birth plan with your care provider before hand and they are not equipped or are unwilling to follow your wishes, then, yes, it is meaningless.

Women who write birth plans are sometimes accused of being "control freaks," and of trying to control something that is uncontrollable (birth). People claim that these uptight women are incapable of submitting to the power of nature that is necessary in natural birth and thus, they can't relax enough to progress and often end up with cesarean sections. However, most of what is in birth plans is actually about avoiding medical control of birth, because these women want nature to control their births, as long as nature is doing well, of course. So, is the beef with birth plans really about submitting to nature or is it about submitting to you? Maybe if physicians stopped trying to control birth themselves and quit trying to force women to follow their medical birth plans (whether written or not), then birth plans wouldn't be necessary?

Your in pain you said I don't want drugs you change your mind you get drugs. Happens everywhere all the time.

The implication here is that wanting an unmediated birth is a naive notion and most women wise up about it once they experience labor.Anyone with this attitude is someone who is likely very unfamiliar with natural birth and will not know how to support a woman in it.This attitude among physicians is exactly why we need doulas who know about natural childbirth to provide women the emotional and physical support they need.

Look the most important thing is not extra personnel in the delivery room. The important thing is a safe and healthy delivery for both the infant and mother. Any mother or father for that matter that thinks anything else is more important should not have children till they get their priorities straight.

Of course having a healthy mother and baby is important.Some people (including some women and some doctors) believe that having a birth with as little medical intervention as possible is a good way to accomplish that goal.It is not harmful for a woman to make sure a medical procedure is really necessary before agreeing to it.Frankly, the insinuation that people who are not willing to just do whatever the doctors want them to shouldn’t have children is insulting.

About Me

I am a mother of three beautiful children. I am a Childbirth International certified doula and a certified Hypnobabies Childbirth Hypnosis Instructor. I am also working on certification as a Dancing For BirthTM instructor.